Organization
VIDALIA ANESTHESIA ASSOC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUNE H TOOTLE (OFFICE MANAGER)
(912) 538-5359
Entity
Organization
Contact information
Practice address
1703 MEADOWS LANE, VIDALIA, GA 30474
(912) 538-5359
(912) 538-5228
Mailing address
PO BOX 1303, VIDALIA, GA 30475-1303
(912) 538-5359
(912) 538-5228
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300033365A
—
GA
01
—
CE7445
MEDICARE RAILROAD
GA
Enumeration date
05/04/2006
Last updated
04/09/2010
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